Healthcare Provider Details

I. General information

NPI: 1679216329
Provider Name (Legal Business Name): GRACE JARRETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LIVINGSTON ST # 3L
BROOKLYN NY
11201-5127
US

IV. Provider business mailing address

45 NORTHERN BLVD
GREENVALE NY
11548-1346
US

V. Phone/Fax

Practice location:
  • Phone: 347-797-5005
  • Fax: 347-212-0308
Mailing address:
  • Phone: 347-797-5005
  • Fax: 347-212-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number028578
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: